A functional unit of Urgent Medical Aid Service (SAMU), Medical-psychological emergency
cell (CUMP) is an emergency medical device and provides immediate and post-immediate
medico-psychological care for mentally injured people in psychotraumatic situations. CUMP
also ensures immediate post follow-up of these patients, as well as departmental
organization of psychotrauma consultation.
During the course of the treatment, victims are oriented, with a telephone callback which
can be decided, allowing a remote reassessment of any psychotraumatic sequelae of the
event. This phone reminder is part of routine practice following a CUMP intervention. The
objective is then early detection of sequelae allowing rapid orientation on specific care
pathways, in particular on the consultation of psychotrauma.
Post-traumatic stress disorder is a syndromic entity reactive to experience of a
traumatogenic event (defined by the brutal, sudden and unexpected confrontation with
death, or the loss of physical or psychological integrity), bringing together intrusive
symptoms of reliving, behavioral avoidance of stimuli related to the traumatic event,
persistent negative alterations in cognitions and mood, and neurovegetative
hyperactivity, causing clinically significant distress and impaired the usual functioning
of the subject.
Experiencing a psychotraumatic event in one's life is a frequent experience.
Epidemiological data show a lifetime prevalence of around 30%. During and/or in the hours
following a psychotraumatic event, people experience psychological, physiological and
emotional upheavals called peritraumatic distress. Although most people recover on their
own, a portion (8.3%) develop post-traumatic stress disorder.
However, one of the main characteristics of post-traumatic stress disorder is the
presence of avoidance symptoms. Avoidance can take different forms such as
non-confrontation with all the evocative clues of the traumatic event such as places,
people and situations related to the traumatic event, but also the avoidance of thoughts,
memories, conversations related to the traumatic event. This avoidance of thoughts and
conversations can be a barrier to entry into trauma-focused psychotherapy. Indeed,
talking about the traumatic event goes against this avoidance. A proactive approach at a
distance from the event to re-evaluate the symptomatology of the people involved and thus
propose an orientation towards specialized care in the field of psychotrauma in order to
counter avoidance would seem entirely relevant.
Indeed, studies show the interest of a telephone follow-up by the Medical-Psychological
Unit 15 days before an emergency repatriation of French people during the Lebanon war in
2016. On the one hand, remote telephone reminder of event is experienced positively by
the people involved in the event and was able to highlight the presence of post-traumatic
stress symptoms in 23% of cases. On the other hand, 56% of people were able to be
referred to appropriate medio-psychological care following this telephone interview.
However, depending on the situation, all of the subjects involved in a psychotraumatic
event cannot be reassessed, especially when event involves too many people. On the other
hand, a significant proportion of subjects will not present psychotraumatic sequelae.
Under these conditions, it seems appropriate to be able to define the proportion of
psychotraumatized subjects most at risk of developing post-traumatic stress disorder
(PTSD). Data from literature find that a high level of peritraumatic distress is largely
associated with severity of post-traumatic stress symptoms .
Thus, peritraumatic distress reactions would be a good indicator of risk of developing a
subsequent post-traumatic stress disorder. Several questionnaires exist to assess this
peritraumatic distress. However, in a disaster situation and in view of the large number
of victims potentially involved, it may be interesting to use a rapid and global
assessment tool.
To do this, the severity item of the global clinical impression scale would respond to
this clinical reality.
Research hypothesis
Hypothesis is that the severity item of the global clinical impression scale evaluated
immediately after in a subject who has experienced a psychotraumatic event is a predictor
of post-traumatic stress symptoms at 1 month and 6 months. Investigators expect a
correlation between the scores of the PDI and the severity item of the global clinical
impression while controlling the socio-demographic characteristics of the worker as well
as his clinical experience. Patients included will have similar profiles and will be
confronted with the same type of traumatic event.
Brief Protocol
Inclusion visit : psychiatric assessment, socio-demographic data, questionnaire (CGI
and Peritraumatic Distress Inventory scale(PDI))
Follow-up visit: M1 and M6 : phone call (Post traumatic stress disorder Checklist
Scale questionnaire (PCL 5), Mini International Neuropsychiatric Interview (MINI) :
major depressive episod, alcohol consumption disorder, substance-related disorder
(non-alcoholic).
Expected results
Investigators expect this work to confirm the prediction between the initial score on the
CGI and the score at M1 and M6 on the PCL5. This result will make it possible to define
an initial threshold for the CGI allowing the occurrence of a constituted post-traumatic
stress disorder to be predicted, defined by a score greater than or equal to 33 on the
PCL5. The objective is to set up a systematic recall protocol for subjects presenting
with a state of acute stress for which an initial CGI score will be higher than the
determined threshold, in order to be able, depending on the subsequent symptomatology, to
offer early management. and focus of post traumatic stress disorder. This reminder
protocol will be integrated into routine practices and deployed on the emergency
reception service of Hospital.